Accuracy, Safety, and Workflow of Frameless Neuronavigation-Guided Stereoelectroencephalography in Drug-Resistant Epilepsy: A Single-Center Cohort Study
Christian Auer, Gudrun Gröppel, Andreas Gruber, Thomas Hauser, Katharina Knogler, Sharon Samueli, Birgit Stark, Gabriela Azevedo Sansoni, Katharina Wach, Tobias RossmannBACKGROUND AND OBJECTIVES:
Stereoelectroencephalography (SEEG) is central to invasive presurgical evaluation in drug-resistant epilepsy (DRE). We evaluated the accuracy, safety, and workflow efficiency of frameless neuronavigation-guided SEEG in routine clinical practice.
METHODS:
This retrospective single-center cohort included consecutive adult and pediatric patients with DRE who underwent SEEG between July 2016 and August 2025. Entry-point and target-point deviations were measured on postoperative computed tomography fused to the preoperative planning data set. Safety end points were perioperative complications. Operative duration and time per electrode were recorded. Comparative analyses between AdTech and Dixi systems were restricted to the primary-surgery cohort to maintain independent samples. A subgroup analysis examined procedures performed by experienced surgeons, defined as more than 250 implanted electrodes.
RESULTS:
Seventy-seven patients underwent 82 SEEG procedures. Across all procedures, 984 electrodes were implanted. The median number of electrodes per surgery was 13. The median entry-point and target-point deviations were 2.1 and 1.8 mm, respectively. Entry-point deviation did not differ between AdTech and Dixi electrodes in the primary-surgery cohort (2.1 vs 2.1 mm;
CONCLUSION:
Frameless neuronavigation-guided SEEG achieved reproducible millimetric accuracy, low morbidity, and efficient workflow in a consecutive real-world cohort. These findings support frameless neuronavigation as a safe and scalable option for invasive presurgical evaluation in DRE.